Abstract
Background
The present study examines impulsivity and posttraumatic stress disorder (PTSD) symptoms as factors that may help understand the relationship between adverse childhood experiences (ACEs) and adolescent binge drinking.
Methods
Data were drawn from a subset of adolescents (N = 285) ages 12–22 from the National Consortium on Alcohol & Neurodevelopment in Adolescence (NCANDA). Impulsivity and PTSD symptoms were each predicted to moderate the relationship between ACEs and binge drinking.
Results
The positive relationship between PTSD symptoms and binge drinking was stronger when impulsivity was included. The positive relationship between ACEs and binge drinking was also strengthened when accounting for PTSD symptoms.
Conclusion
Our results provide evidence that impulsivity and PTSD symptoms may increase the risk for binge drinking during adolescence, including following ACEs. Interventions targeting PTSD symptoms and impulsivity could be valuable tools in preventing adolescent binge drinking.
This is a preview of subscription content, access via your institution.

Data Availability
The data that support the findings of this study are available from the National Consortium on Alcohol and Neurodevelopment in Adolescence (NCANDA) and National Institute on Alcohol Abuse and Alcoholism (NIAAA). Restrictions apply to the availability of these data, which were used under a data distribution agreement for this study.
References
Andersen, S. L., & Teicher, M. H. (2009). Desperately driven and no brakes: Developmental stress exposure and subsequent risk for substance abuse. Neuroscience & Biobehavioral Reviews, 33(4), 516–524. https://doi.org/10.1016/j.neubiorev.2008.09.009
Armstrong, R. A. (2014). When to use the Bonferroni correction. Ophthalmic and Physiological Optics, 34(5), 502–508. https://doi.org/10.1111/opo.12131
Baron, R. M., & Kenny, D. A. (1986). The moderator–mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51(6), 1173–1182. https://doi.org/10.1037/0022-3514.51.6.1173
Bernstein, D. P., Stein, J. A., Newcomb, M. D., Walker, E., Pogge, D., Ahluvalia, T., Stokes, J., Handelsman, L., Medrano, M., Desmond, D., & Zule, W. (2003). Development and validation of a brief screening version of the Childhood Trauma Questionnaire. Child Abuse & Neglect, 27(2), 169–190. https://doi.org/10.1016/S0145-2134(02)00541-0
Bethell, C., Davis, M., Gombojav, N., Stumbo, S., & Powers, K. (2017). Issue Brief: Adverse childhood experiences among US children, child and adolescent health measurement initiative, Johns Hopkins Bloomberg School of Public Health, October 2017. http://www.cahmi.org/projects/adverse-childhood-experiences-aces/
Bick, J., & Nelson, C. A. (2016). Early adverse experiences and the developing brain. Neuropsychopharmacology, 41(1), 177–196. https://doi.org/10.1038/npp.2015.252
Bø, R., Billieux, J., & Landrø, N. I. (2016). Which facets of impulsivity predict binge drinking? Addictive Behaviors Reports, 3, 43–47. https://doi.org/10.1016/j.abrep.2016.03.001
Brady, K. T., Back, S. E., & Coffey, S. F. (2004). Substance abuse and posttraumatic stress disorder. Current Directions in Psychological Science, 13(5), 206–209. https://doi.org/10.1111/j.0963-7214.2004.00309.x
Brown, T. A., Chorpita, B. F., & Barlow, D. H. (1998). Structural relationships among dimensions of the DSM-IV anxiety and mood disorders and dimensions of negative affect, positive affect, and autonomic arousal. Journal of Abnormal Psychology, 107(2), 179–192. https://doi.org/10.1037/0021-843X.107.2.179
Brown, S. A., Brumback, T., Tomlinson, K., Cummins, K., Thompson, W. K., Nagel, B. J., De Bellis, M. D., Hooper, S. R., Clark, D. B., Chung, T., Hasler, B. P., Colrain, I. M., Baker, F. C., Prouty, D., Pfefferbaum, A., Sullivan, E. V., Pohl, K. M., Rohlfing, T., Nichols, B. N., … Tapert, S. F. (2015). The National Consortium on Alcohol and NeuroDevelopment in Adolescence (NCANDA): A multisite study of adolescent development and substance use. Journal of Studies on Alcohol and Drugs, 76(6), 895–908. https://doi.org/10.15288/jsad.2015.76.895
Bucholz, K. K., Cadoret, R., Cloninger, C. R., Dinwiddie, S. H., Hesselbrock, V. M., Nurnberger, J. I., Reich, T., Schmidt, I., & Schuckit, M. A. (1994a). A new, semi-structured psychiatric interview for use in genetic linkage studies. Journal of Studies on Alcohol, 55, 149–158.
Bucholz, K. K., Cadoret, R., Cloninger, C. R., Dinwiddie, S. H., Hesselbrock, V. M., Nurnberger, J. I., Reich, T., Schmidt, I., & Schuckit, M. A. (1999b). A new, semi-structured psychiatric interview for use in genetic linkage studies: A report on the reliability of the SSAGA. Journal of Studies on Alcohol, 55(2), 149–158. https://doi.org/10.15288/jsa.1994b.55.149
Centers for Disease Control and Prevention. (2015). US department of health, and human services. (2013). REPORT—Antibiotic Resistance Threats in the United States, 1–114.
Chung, T., Creswell, K. G., Bachrach, R., Clark, D. B., & Martin, C. S. (2018). Adolescent binge drinking. Alcohol Research: Current Reviews, 39(1), 5–15.
Clark, D. B., Chung, T., Martin, C. S., Hasler, B. P., Fitzgerald, D. H., Luna, B., Brown, S. A., Tapert, S. F., Brumback, T., Cummins, K., Pfefferbaum, A., Sullivan, E. V., Pohl, K. M., Colrain, I. M., Baker, F. C., De Bellis, M. D., Nooner, K. B., & Nagel, B. J. (2017). Adolescent executive dysfunction in daily life: Relationships to risks, brain structure and substance use. Frontiers in Behavioral Neuroscience, 11, 223. https://doi.org/10.3389/fnbeh.2017.00223
Cole, J., Sprang, G., & Silman, M. (2019). Interpersonal trauma exposure, trauma symptoms, and severity of substance use disorder among youth entering outpatient substance abuse treatment. Journal of Child & Adolescent Trauma, 12(3), 341–349. https://doi.org/10.1007/s40653-018-0239-3
Coskunpinar, A., Dir, A. L., & Cyders, M. A. (2013). Multidimensionality in impulsivity and alcohol use: A meta-analysis using the UPPS model of impulsivity. Alcoholism: Clinical and Experimental Research, 37(9), 1441–1450. https://doi.org/10.1111/acer.12131
Danese, A., & McEwen, B. S. (2012). Adverse childhood experiences, allostasis, allostatic load, and age-related disease. Physiology & Behavior, 106(1), 29–39. https://doi.org/10.1016/j.physbeh.2011.08.019
De Bellis, M. D. (2001). Developmental traumatology: The psychobiological development of maltreated children and its implications for research, treatment, and policy. Development and Psychopathology, 13(3), 539–564. https://doi.org/10.1017/S0954579401003078
De Bellis, M. D. (2002). Developmental traumatology: A contributory mechanism for alcohol and substance use disorders. Psychoneuroendocrinology, 27(1–2), 155–170.
De Bellis, M. D., Nooner, K. B., Brumback, T., Clark, D. B., Tapert, S. F., & Brown, S. A. (2020). Posttraumatic stress symptoms predict transition to future adolescent and young adult moderate to heavy drinking in the NCANDA sample. Current Addiction Reports, 7(2), 99–107. https://doi.org/10.1007/s40429-020-00303-1
Degenhardt, L., O’Loughlin, C., Swift, W., Romaniuk, H., Carlin, J., Coffey, C., Hall, W., & Patton, G. (2013). The persistence of adolescent binge drinking into adulthood: Findings from a 15-year prospective cohort study. British Medical Journal Open, 3(8), e003015. https://doi.org/10.1136/bmjopen-2013-003015
Dube, S. R., Anda, R. F., Felitti, V. J., Edwards, V. J., & Croft, J. B. (2002). Adverse childhood experiences and personal alcohol abuse as an adult. Addictive Behaviors, 27(5), 713–725.
Dube, S. R., Felitti, V. J., Dong, M., Chapman, D. P., Giles, W. H., & Anda, R. F. (2003). Childhood abuse, neglect, household dysfunction and the risk of illicit drug use: The adverse childhood experiences Study. Pediatrics, 111(3), 564–572.
Dube, S. R., Anda, R. F., Whitfield, C. L., Brown, D. W., Felitti, V. J., Dong, M., & Giles, W. H. (2005). Long-term consequences of childhood sexual abuse by gender of victim. American Journal of Preventive Medicine, 28(5), 430–438. https://doi.org/10.1016/j.amepre.2005.01.015
Fang, L., & McNeil, S. (2017). Is there a relationship between adverse childhood experiences and problem drinking behaviors? Findings from a population-based sample. Public Health, 150, 34–42. https://doi.org/10.1016/j.puhe.2017.05.005
Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. American Journal of Preventive Medicine, 14(4), 245–258. https://doi.org/10.1016/S0749-3797(98)00017-8
Glaser, D. (2000). Child abuse and neglect and the brain—A review. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 41(1), 97–116.
Haaris Sheikh, M., Naveed, S., Waqas, A., & Tahir Jaura, I. (2018). Association of adverse childhood experiences with functional identity and impulsivity among adults: A cross-sectional study. Research, 6, 1978. https://doi.org/10.12688/f1000research.13007.2
Hesselbrock, M., Easton, C., Bucholz, K. K., Schuckit, M., & Hesselbrock, V. (1999). A validity study of the SSAGA–A comparison with the SCAN. Addiction, 94(9), 1361–1370. https://doi.org/10.1046/j.1360-0443.1999.94913618.x
Hingson, R. W., Heeren, T., & Winter, M. R. (2006). Age at drinking onset and alcohol dependence: Age at onset, duration, and severity. Archives of Pediatrics & Adolescent Medicine, 160(7), 739. https://doi.org/10.1001/archpedi.160.7.739
Jacobsen, L. K., Southwick, S. M., & Kosten, T. R. (2001). Substance use disorders in patients with posttraumatic stress disorder: A review of the literature. American Journal of Psychiatry, 158(8), 1184–1190. https://doi.org/10.1176/appi.ajp.158.8.1184
Jacobus, J., Thayer, R. E., Trim, R. S., Bava, S., Frank, L. R., & Tapert, S. F. (2013). White matter integrity, substance use, and risk taking in adolescence. Psychology of Addictive Behaviors, 27(2), 431–442. https://doi.org/10.1037/a0028235
Jakupcak, M., Tull, M. T., McDermott, M. J., Kaysen, D., Hunt, S., & Simpson, T. (2010). PTSD symptom clusters in relationship to alcohol misuse among Iraq and Afghanistan war veterans seeking post-deployment VA health care. Addictive Behaviors, 35(9), 840–843. https://doi.org/10.1016/j.addbeh.2010.03.023
Jaycox, L. H., Ebener, P., Damesek, L., & Becker, K. (2004). Trauma exposure and retention in adolescent substance abuse treatment. Journal of Traumatic Stress, 17(2), 113–121. https://doi.org/10.1023/B:JOTS.0000022617.41299.39
Johnston, L. D., O’Malley, P. M., Miech, R. A., Bachman, J. G., & Schulenberg, J. E. (2016). Monitoring the future national survey results on drug use, 1975–2015: Overview, key findings on adolescent drug use. The University of Michigan.
Kim, J. H., & Choi, J. Y. (2020). Influence of childhood trauma and posttraumatic stress symptoms on impulsivity: Focusing on differences according to the dimensions of impulsivity. European Journal of Psychotraumatology, 11(1), 1796276. https://doi.org/10.1080/20008198.2020.1796276
Kirsch, D., Nemeroff, C. M., & Lippard, E. T. C. (2020). Early life stress and substance use disorders: Underlying neurobiology and pathways to adverse outcomes. Adversity and Resilience Science, 1(1), 29–47. https://doi.org/10.1007/s42844-020-00005-7
Lejuez, C. W., Magidson, J. F., Mitchell, S. H., Sinha, R., Stevens, M. C., & De Wit, H. (2010). Behavioral and biological indicators of impulsivity in the development of alcohol use, problems, and disorders: IMPULSIVITY AND AUDS. Alcoholism: Clinical and Experimental Research, no-no. https://doi.org/10.1111/j.1530-0277.2010.01217.x
Long, J. S. (1997). Regression models for categorical and limited dependent variables. Sage Publications.
MacKillop, J., Amlung, M. T., Few, L. R., Ray, L. A., Sweet, L. H., & Munafò, M. R. (2011). Delayed reward discounting and addictive behavior: A meta-analysis. Psychopharmacology (berl), 216(3), 305–321. https://doi.org/10.1007/s00213-011-2229-0
Madden, G. J., & Bickel, W. K. (Eds.). (2010). Impulsivity: The behavioral and neurological science of discounting. American Psychological Association. https://doi.org/10.1037/12069-000
McKinney, C. M., Harris, T. R., & Caetano, R. (2009). Reliability of self-reported childhood physical abuse by adults and factors predictive of inconsistent reporting. Violence and Victims, 24(5), 653–668. https://doi.org/10.1891/0886-6708.24.5.653
Moeller, F. G., Barratt, E. S., Dougherty, D. M., Schmitz, J. M., & Swann, A. C. (2001). Psychiatric aspects of impulsivity. American Journal of Psychiatry, 158(11), 1783–1793. https://doi.org/10.1176/appi.ajp.158.11.1783
National Institute of Alcohol Abuse and Alcoholism. (2004). NIAAA council approves definition of binge drinking. NIAAA Newsletter.
Norman, S. B., Stein, M. B., & Davidson, J. R. T. (2007a). Profiling posttraumatic functional impairment. The Journal of Nervous and Mental Disease, 195(1), 48–53. https://doi.org/10.1097/01.nmd.0000252135.25114.02
Norman, S. B., Tate, S. R., Anderson, K. G., & Brown, S. A. (2007b). Do trauma history and PTSD symptoms influence addiction relapse context? Drug and Alcohol Dependence, 90(1), 89–96. https://doi.org/10.1016/j.drugalcdep.2007.03.002
Oberleitner, L. M. S., Smith, P. H., Weinberger, A. H., Mazure, C. M., & McKee, S. A. (2015). Impact of exposure to childhood maltreatment on transitions to alcohol dependence in women and men. Child Maltreatment, 20(4), 301–308. https://doi.org/10.1177/1077559515591270
Petersen, A. C., Crockett, L., Richards, M., & Boxer, A. (1988). A self-report measure of pubertal status: Reliability, validity, and initial norms. Journal of Youth and Adolescence, 17(2), 117–133.
Pfefferbaum, A., Kwon, D., Brumback, T., Thomson, W. K., Cummins, K., Tapert, S. F., Brown, S. A., Thompson, W., Colrain, I., Baker, F., Prouty, D., De Bellis, M. D., Clark, D. B., Nagel, B., Chu, W., Park, S. H., Pohl, K. M., & Sullivan, E. V. (2018). Altered brain developmental FC, trajectories in adolescents after initiating drinking. American Journal of Psychiatry, 175(4), 370–380.
Pfefferbaum, A., Rohlfing, T., Pohl, K. M., Lane, B., Chu, W., Kwon, D., Nolan Nichols, B., Brown, S. A., Tapert, S. F., Cummins, K., Thompson, W. K., Brumback, T., Meloy, M. J., Jernigan, T. L., Dale, A., Colrain, I. M., Baker, F. C., Prouty, D., De Bellis, M. D., … Sullivan, E. V. (2016). Adolescent development of cortical and white matter structure in the NCANDA sample: role of sex, ethnicity, puberty, and alcohol drinking. Cerebral Cortex, 26(10), 4101–4121.https://doi.org/10.1093/cercor/bhv205
Preacher, K. J., Curran, P. J., & Bauer, D. J. (2006). Computational tools for probing interactions in multiple linear regression, multilevel modeling, and latent curve analysis. Journal of Educational and Behavioral Statistics, 31(4), 437–448. https://doi.org/10.3102/10769986031004437
Pynoos, R. S., Steinberg, A. M., & Piacentini, J. C. (1999). A developmental psychopathology model of childhood traumatic stress and intersection with anxiety disorders. Biological Psychiatry, 46(11), 1542–1554. https://doi.org/10.1016/S0006-3223(99)00262-0
Secades-Villa, R., Martínez-Loredo, V., Grande-Gosende, A., & Fernández-Hermida, J. R. (2016). The relationship between impulsivity and problem gambling in adolescence. Frontiers in Psychology, 7.https://doi.org/10.3389/fpsyg.2016.01931
Shin, S. H., Edwards, E. M., & Heeren, T. (2009). Child abuse and neglect: Relations to adolescent binge drinking in the national longitudinal study of Adolescent Health (AddHealth) Study. Addictive Behaviors, 34(3), 277–280. https://doi.org/10.1016/j.addbeh.2008.10.023
Shin, S. H., Hong, H. G., & Jeon, S.-M. (2012). Personality and alcohol use: The role of impulsivity. Addictive Behaviors, 37(1), 102–107. https://doi.org/10.1016/j.addbeh.2011.09.006
Shin, S. H., Miller, D. P., & Teicher, M. H. (2013). Exposure to childhood neglect and physical abuse and developmental trajectories of heavy episodic drinking from early adolescence into young adulthood. Drug and Alcohol Dependence, 127(1–3), 31–38. https://doi.org/10.1016/j.drugalcdep.2012.06.005
Shin, S. H., Lee, S., Jeon, S.-M., & Wills, T. A. (2015). Childhood emotional abuse, negative emotion-driven impulsivity, and alcohol use in young adulthood. Child Abuse & Neglect, 50, 94–103. https://doi.org/10.1016/j.chiabu.2015.02.010
Shin, S. H., McDonald, S. E., & Conley, D. (2018). Patterns of adverse childhood experiences and substance use among young adults: A latent class analysis. Addictive Behaviors, 78, 187–192. https://doi.org/10.1016/j.addbeh.2017.11.020
Silveri, M. M. (2012). Adolescent brain development and underage drinking in the United States: Identifying risks of alcohol use in college populations. Harvard Review of Psychiatry, 20(4), 189–200. https://doi.org/10.3109/10673229.2012.714642
Sinha, R. (2009). Stress and addiction: A dynamic interplay of genes, environment, and drug intake. Biological Psychiatry, 66(2), 100–101. https://doi.org/10.1016/j.biopsych.2009.05.003
Skeer, M., McCormick, M. C., Normand, S.-L.T., Buka, S. L., & Gilman, S. E. (2009). A prospective study of familial conflict, psychological stress, and the development of substance use disorders in adolescence. Drug and Alcohol Dependence, 104(1–2), 65–72. https://doi.org/10.1016/j.drugalcdep.2009.03.017
Southwick, S. M., Bremner, J. D., Rasmusson, A., Morgan, C. A., Arnsten, A., & Charney, D. S. (1999). Role of norepinephrine in the pathophysiology and treatment of posttraumatic stress disorder. Biological Psychiatry, 46(9), 1192–1204. https://doi.org/10.1016/S0006-3223(99)00219-X
Squeglia, L. M., & Gray, K. M. (2016). Alcohol and drug use and the developing brain. Current Psychiatry Reports, 18(5), 46. https://doi.org/10.1007/s11920-016-0689-y
Stanger, C., Ryan, S. R., Fu, H., Landes, R. D., Jones, B. A., Bickel, W. K., & Budney, A. J. (2012). Delay discounting predicts adolescent substance abuse treatment outcome. Experimental and Clinical Psychopharmacology, 20(3), 205–212. https://doi.org/10.1037/a0026543
Steward, T., Mestre-Bach, G., Fernández-Aranda, F., Granero, R., Perales, J. C., Navas, J. F., Soriano-Mas, C., Baño, M., Fernández-Formoso, J. A., Martín-Romera, V., Menchón, J. M., & Jiménez-Murcia, S. (2017). Delay discounting and impulsivity traits in young and older gambling disorder patients. Addictive Behaviors, 71, 96–103. https://doi.org/10.1016/j.addbeh.2017.03.001
Strine, T. (2012). Associations between adverse childhood experiences, psychological distress, and adult alcohol problems. American Journal of Health Behavior, 36(3). https://doi.org/10.5993/AJHB.36.3.11
Sullivan, E. V., Brumback, T., Tapert, S. F., Fama, R., Prouty, D., Brown, S. A., Cummins, K., Thompson, W. K., Colrain, I. M., Baker, F. C., De Bellis, M. D., Hooper, S. R., Clark, D. B., Chung, T., Nagel, B. J., Nichols, B. N., Rohlfing, T., Chu, W., Pohl, K. M., & Pfefferbaum, A. (2016). Cognitive, emotion control, and motor performance of adolescents in the NCANDA study: Contributions from alcohol consumption, age, sex, ethnicity, and family history of addiction. Neuropsychology, 30(4), 449–473. https://doi.org/10.1037/neu0000259
Tarter, R. E., Kirisci, L., Mezzich, A., Cornelius, J. R., Pajer, K., Vanyukov, M., Gardner, W., Blackson, T., & Clark, D. (2003). Neurobehavioral disinhibition in childhood predicts early age at onset of substance use disorder. American Journal of Psychiatry, 160(6), 1078–1085. https://doi.org/10.1176/appi.ajp.160.6.1078
Townshend, J. M., Kambouropoulos, N., Griffin, A., Hunt, F. J., & Milani, R. M. (2014). Binge drinking, reflection impulsivity, and unplanned sexual behavior: Impaired decision-making in young social drinkers. Alcoholism: Clinical and Experimental Research, 38(4), 1143–1150. https://doi.org/10.1111/acer.12333
Twardosz, S., & Lutzker, J. R. (2010). Child maltreatment and the developing brain: A review of neuroscience perspectives. Aggression and Violent Behavior, 15(1), 59–68. https://doi.org/10.1016/j.avb.2009.08.003
Walker, J., Bountress, K. E., Calhoun, C. D., Metzger, I. W., Adams, Z., Amstadter, A., Thomas, S., & Danielson, C. K. (2018). Impulsivity and comorbid PTSD and binge drinking. Journal of Dual Diagnosis, 14(2), 89–95. https://doi.org/10.1080/15504263.2018.1439212
Wardell, J. D., Strang, N. M., & Hendershot, C. S. (2016). Negative urgency mediates the relationship between childhood maltreatment and problems with alcohol and cannabis in late adolescence. Addictive Behaviors, 56, 1–7. https://doi.org/10.1016/j.addbeh.2016.01.003
Weiss, N. H., Tull, M. T., Viana, A. G., Anestis, M. D., & Gratz, K. L. (2012). Impulsive behaviors as an emotion regulation strategy: Examining associations between PTSD, emotion dysregulation, and impulsive behaviors among substance dependent inpatients. Journal of Anxiety Disorders, 26(3), 453–458. https://doi.org/10.1016/j.janxdis.2012.01.007
Funding
This work was made possible with support by NIH Grants AA021697, AA021695, AA021692, AA021696, AA021681, AA021690, and AA021691. Data used here are from the data release NCANDA_PUBLIC_4Y_REDCAP_V02 (https://dx.doi.org/10.7303/syn24226662) distributed to the public according to the NCANDA Data Distribution agreement.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
The authors declare no competing interests.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Arwood, Z., Nooner, K.B. Adverse Childhood Experiences and Binge Drinking in Adolescence: the Role of Impulsivity and PTSD Symptoms. J Pediatr Neuropsychol 9, 30–41 (2023). https://doi.org/10.1007/s40817-022-00135-z
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40817-022-00135-z
Keywords
- Adverse childhood experiences
- Impulsivity
- Posttraumatic stress disorder
- Binge drinking
- Adolescence
- Neurodevelopment